HomeMy WebLinkAboutCOM2012-00016 Cancelled Change in Tenant - COM Application - 3/20/2012 MASON COUNTY Y1(1
CHANGE IN TENANT APPLICATION �- I
Complete the Change in Tenant Application and return with a floor plan, site plan, septic pumpers rep , septic re Vd
fee to the Mason County Permit Center, P.O. Box 186, Shelton,WA 98584. Evaluation of the Change in Tenant Application will involve
staff members from the Building, Fire Marshal, Environmental Health, Planning and Public Works offices who will identify compliance
requirements. This application is intended for tenant change only. If construction or remodeling is proposed or required a building
permit will be necessary. Upon approval the permit will be issued to the applicant/tenant. After the permit is issued, schedule an
inspection by calling (360)427-7262. Upon satisfactory inspection a Certificate of Occupancy will be issued and must be posted in a
conspicuous place on the premises.
PROPERTY INFORMATION
Date: a 22 201A - Assessor's Parcel Number:
Legal De cripti n: U ��
Building Site Address: 6u
Method of sewage disposal: O Septic O Sewer— name of district:
Water source: O Individual Well O Community Well O Public System, name of system:
PEOPLE INVOLVED IN THE PROJECT
Name of Applicant:
Mailing address: - �, .
City: State: Zip.
Day phon Contact Person:V Message phon
PROD CT INFORIIQATION
Pro osed business name: Z,kfi unaU'1
Propo d use: Lo_ b ( Number of employees:
Previous bu,,siness nam : —D I
Describe pre •ous use:
STRUCTURE DETAILS
Check one: O tached single level/single tenant O Single level/ multi tenant
O Mu i level/single tenant • Multi level/multi tenant
Age of structure: 2 Is structure cur ly If not occupied, hnW Ion has it been v 5a t?
I\Qccupied? ( Yesj No Yr. Mo. Orit f MCAS
Square footage: Basement. irst: Mezzanine: Second: hird:
Is the structutr heated? I HeatN type: circle-me:
Circle one: !Yes No Electnc Liquid Propane Natural Gas Oil
Type of heat: Circle one: Furnace at P lectric baseboard or wall mount Radiant
Wi re be any anges to the following? Circle yes or no,if applicable:
Floor lay-out: Yes Lighting: Yes N Heating: Yesxterior Finishes: Yes No Interior Fini es: Yes o Parking: Yes Co
Number of restrooms provi ed: Number fixtures in each
Is structure handicap accessible? Circle one Yes o
Is the structure equipped with a fire sprinkler system? No Fire alarm system? Yes No
Monitoring Station Name: Phone number:
APPLICATION WILL NOT BE CCEPTED W OUT:
1. ' Floor Plan(5 sets):
• Draw the floor plan to scale 0Us f rooms
• Room Dimensions • Locati of all Ue � w1ndows(include dimensions)
• Location of plumbingand mechanical fixtures • Interior rs with swing radius
2. Site Plan(5 sets): -Note scale used
• Property lines, as e t right of ways • Location of I ` 'ng tructures&dimensions
• Distance,. pr y line&structures • Landsca r rds
• -sac e t and dr in fields, &reserve • II aN'drS
• LCstiDn d� icle access roads • Pa i areas number arran e
9 Y
3. Septic records,pumper's report or O&M report.
4. Fees will be collected at time of submittal
Official Use Only
Accepted b Date 2 Submittal Amount$ Receipt numb r
7 Department R vie Initials Date Comments
Building
Environmental Health
Fire Marshal 3—,7
Planning
Public Works
Occupancy Change? (circle one) Yes No Type of construction
Occupancy classification change from to Occupant load calculated: persons
Existing occupant load design persons. Land Use Designation:
Occupancy Classification:
�r0 --
�- athroom Bathroom shared Bathroom 1
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N +may ;I SUITE 11 \ - —-J
F� N SIIITE #4
SELECT CLIiNIC,4 HOOD CANAL TRAVEL
SIIITE 12 SUITE #3
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I �i� l e ( STATE FARM INSURANCE' CLIPPER BARBER
(Berg) SHOP _
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\r q COUNTY c APPP 'lsF�D
MASON p . .
+- ; ., ,iG PLANNING :
SITE PLAN REQUiRE ',;; ,
ALL SETBACKS ARE MEASURED
—Al r I \I ^� O�� CHANGES 5UE3JE�: TC?,{ I`:/qL
VJCJ C� �By FROM THE FURTHEST
2-2 JECTION OF THE SUILDING